technetium-tc-99m-disofenin and Cholelithiasis

Acalculous biliary pain has been related to gallbladder dysfunction that produces a gallbladder emptying defect-a condition which favours the development of lithiasis. It is therefore probable that microlithiasis is present in patients with gallbladder dysfunction. The aims of this study were to measure gallbladder emptying and investigate bile abnormalities in patients with acalculous biliary pain. In 92 consecutive patients, gallbladder emptying was assessed by quantitative cholescintigraphy (abnormal ejection fraction < or =40%). In 64 patients, a microscopic study was performed on duodenal bile, defining abnormality as the presence of cholesterol crystals in any amount and/or calcium bilirubinate granules and/or microspheroliths at a rate of >10 per slide. The ejection fraction was abnormal in 45 patients (49%) (median 25.1%, range 6.8-39.3%) and normal in the remaining 47 cases (median 71.3%, range 41.0-96.1%). Bile was abnormal in 32 of 64 patients (50%), the most frequent finding being calcium bilirubinate granules. In the patients with bile abnormalities, abnormal ejection fraction was more frequent (20 of 32) and the median ejection fraction was lower (30.9%, range 12.0-94.1%) than in the patients with normal bile (16 of 32 with an abnormal ejection fraction; median ejection fraction 50.7%, range 6.8-96.1%). Abnormal bile was frequent (55.5%) in patients with reduced ejection fraction, but was not uncommon in patients with normal ejection fraction (33.3%). Fewer patients showed no alteration (25%). It is concluded that in most patients, acalculous biliary pain coexists with gallbladder dysfunction or abnormal bile, the combination of both alterations being common.

Topics: Abdominal Pain; Acalculous Cholecystitis; Adult; Bile; Cholecystokinin; Cholelithiasis; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Statistics as Topic; Technetium Tc 99m Disofenin

Aerobic exercise may influence gallstone disease pathogenesis through its effect on gallbladder motility. The purpose of this investigation was to examine the effects of exercise training on gallbladder emptying in obese women.. Twenty-seven obese subjects were randomized into one of two groups: exercise (E) (five 45-min brisk walking sessions per week at 75.2 +/- 0.5% of maximum heart rate) and controls (C). Gallbladder function via cholescintigraphy, cardiorespiratory fitness, and body composition were measured in all subjects before and after a 12-wk intervention period. In each cholescintigraphy trial subjects ingested an 8-oz liquid meal 45 min after injection of 99mTc disofenin to promote gallbladder emptying. Gallbladder areas were then scanned for 60 s and then every 5 min for 60 min.. VO2max increased significantly by 9% for E when compared with that for C (P < 0.001). Within E postprandial gallbladder ejection fraction (EF) increased significantly after training (39.5 +/- 4.9% to 54.7 +/- 6.5%, P < 0.05); however, this 15.2% increase in EF was not significantly greater than the change reported in the controls.. Results indicate that 12 wk of moderate exercise training does improve cardiorespiratory fitness but does not significantly effect gallbladder emptying in obese women.

Topics: Adult; Analysis of Variance; Cholelithiasis; Exercise Therapy; Female; Gallbladder; Gallbladder Emptying; Heart; Heart Rate; Humans; Lung; Middle Aged; Obesity; Oxygen Consumption; Physical Fitness; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Disofenin; Walking

Thirteen patients with gallbladder sludge, 14 patients with gallstones and 24 control cases with normal gallbladders were included in the study. Gallbladder function was represented as the filling fraction (FF) and the ejection fraction (EF) calculated using quantitative 99Tcm-DISIDA cholescintigraphy and compared in the groups. The results showed that (1) the patients with normal gallbladders had the highest FF and EF, (2) those with gallstones had the lowest FF, (3) the patients with gallbladder sludge had the lowest EF, and (4) the coefficient of variation (CV) of FF and EF of the normal controls were less than those for the patients with gallstones or sludge. There was only a statistically significant difference between the normal controls and the patients with gallstones for FF. However, no significant differences existed among the three groups for EF. In our preliminary results, we found that gallbladder sludge or stones may impair gallbladder function, especially FF, as evidenced by noninvasive and quantitative 99Tcm-DISIDA cholescintigraphy, and the higher CV value suggests that gallbladder function in patients with gallstones or sludge is more variable.

Topics: Aged; Analysis of Variance; Cholelithiasis; Female; Gallbladder; Gallbladder Diseases; Humans; Imino Acids; Male; Organotechnetium Compounds; Radionuclide Imaging; Reference Values; Technetium Tc 99m Disofenin

99mTc-disofenin, a derivative of iminodiacetic acid, was used for cholescintigraphy in 6 volunteers (in addition to assessment of blood and urine clearance) and in 82 patients referred for evaluation of hepatobiliary tract disease. This radionuclide was cleared rapidly from the blood by the hepatocytes, which permitted satisfactory to excellent images of the hepatobiliary system; interference by renal activity was seen in only 9/82 patients (11%). Acute cholecystitis was correctly diagnosed in 20 patients, although 9 (45%) had jaundice; bilirubin levels ranged from 1.2 to 7.6 mg/dl. The biliary tract was normal in 16 of the 27 patients with jaundice (60%).

Topics: Bile Ducts; Cholangiography; Cholecystitis; Cholelithiasis; Cholestasis, Intrahepatic; Clinical Trials as Topic; Humans; Imino Acids; Liver; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Patients with acalculous biliary-like pain present a difficult clinical challenge. Our aim was to evaluate the outcome of patients with recurrent biliary-like pain without gallstones who underwent testing of gallbladder ejection fraction (GBEF) by cholecystokinin-cholescintigraphy (CCK-CS) in order to determine clinical factors that may predict symptom resolution. We reviewed the records of patients with recurrent acalculous biliary-like pain who underwent CCK-CS from January 1995 to December 1999. For comparison, we also studied an age- and sex-matched group of patients who underwent cholecystectomy for symptomatic cholelithiasis. Outcome was obtained by telephone interview, using a scale from 0 to 3 where 0 = no improvement and 3 = clinical remission. Patient demographics, predominant symptom(s), method of management, gallbladder pathology, and response to treatment were recorded. One hundred twenty-nine patients underwent CCK-CS. Of 69 with an abnormal GBEF, 48 (70%) were available for interview. Forty patients underwent cholecystectomy. Twenty-seven patients reported symptom resolution after surgery while 4 nonsurgical patients reported the same (P = NS). Univariate analysis revealed no association between symptom outcome and presence of gastrointestinal symptom(s), severity and duration of abdominal pain, management, or gallbladder pathology. In addition, no GBEF cutoff level predicted symptom outcome. Of the remaining 60 patients with a normal GBEF, 30 (50%) were available for interview. Twenty-eight patients in this group were managed medically and 2 patients underwent cholecystectomy. Eighteen patients managed medically were asymptomatic, as were the 2 who underwent cholecystectomy. There was no difference in symptom outcome between patients who had GBEF >35% vs <35%. In conclusion, in a group of patients with recurrent acalculous biliary-like pain who underwent CCK-CS, we found a high rate of symptom resolution following cholecystectomy; however, this was not statistically different from a smaller cohort who did not undergo surgery. We were unable to determine any variable predictive of symptom resolution.

Topics: Abdominal Pain; Adult; Analysis of Variance; Biliary Dyskinesia; Cholecystectomy; Cholecystokinin; Cholelithiasis; Cohort Studies; Female; Gallbladder Diseases; Gallbladder Emptying; Humans; Male; Middle Aged; Probability; Prognosis; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Disofenin

Hepatobiliary scintigraphy is an established method for the diagnosis of a bile leak from the biliary system. A bile leak should be considered in any patient after cholecystectomy who has unexplained abdominal pain after operation. Three patients with bile leak diagnosed by scintigraphy are described, one of whom had an unusual pattern of hepatic subcapsular collection of the bile. The second patient had a bile leak through the postsurgical drainage tube, whereas the third patient had a more typical pattern of leakage into the peritoneal cavity.

Topics: Abdominal Pain; Adult; Aged; Bile Duct Diseases; Bile Ducts; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Cholecystectomy, Laparoscopic; Cholelithiasis; Drainage; Female; Humans; Injections, Intravenous; Male; Postoperative Nausea and Vomiting; Radionuclide Imaging; Reoperation; Rupture, Spontaneous; Sensitivity and Specificity; Stents; Technetium Tc 99m Disofenin

Drug related false-positive hepatobiliary imaging is uncommon. The authors present a case of a 54-year-old woman who was treated with intravenous ceftriaxone for bacterial meningitis. Symptoms of acute cholecystitis subsequently developed and a sonogram revealed a gallstone. A Tc-99m DISIDA hepatobiliary study was positive for cystic duct obstruction. After discontinuation of ceftriaxone, the patient's clinical condition improved and, 2 weeks later, a repeat hepatobiliary scan was normal. High doses of ceftriaxone and prolonged administration may lead to formation of pseudocholelithiasis and signs of acute cholecystitis. Although this condition is usually benign and reversible, discontinuation of the drug is warranted when symptoms of acute cholecystitis are accompanied by a positive hepatobiliary scan.

Topics: Ceftriaxone; Cephalosporins; Cholecystitis; Cholelithiasis; False Positive Reactions; Female; Gallbladder; Humans; Imino Acids; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Perforation of the gallbladder in patients with chronic cholecystitis is rarely diagnosed preoperatively. We describe a case in which early cholescintigraphy permitted preoperative diagnosis and, therefore, prompt laparotomy.

Topics: Cholelithiasis; Gallbladder Diseases; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Preoperative Care; Radionuclide Imaging; Rupture, Spontaneous; Technetium Tc 99m Disofenin

Endoscopic sphincterotomy has been used for the treatment of many biliary disorders, including extraction of obstructing common bile duct stones. Manometric studies of the sphincter of Oddi and the common bile duct have shown a marked decrease in biliary tract pressures after sphincterotomy. A prospective study of 12 patients with intact gallbladders using hepatobiliary imaging before and after sphincterotomy was performed to assess changes in bile dynamics. Nonfilling of the gallbladder occurred in 9 of the 12 patients after sphincterotomy, indicating significant alteration of bile flow. Such changes in bile dynamics may have serious implications in patients selected for medical dissolution of gallstones. It may also adversely affect specificity of cholescintigraphy in diagnosing acute cholecystitis.

Topics: Adult; Aged; Aged, 80 and over; Bile; Cholecystitis; Cholelithiasis; Cholestasis, Extrahepatic; Common Bile Duct; Common Bile Duct Diseases; Female; Gallbladder; Gallstones; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Pressure; Prospective Studies; Radionuclide Imaging; Sphincter of Oddi; Sphincterotomy, Endoscopic; Technetium Tc 99m Disofenin

We assessed changes of gallbladder function including concentration and contraction in patients with gallstones after extracorporeal shockwave lithotripsy (ESWL). The abilities of concentration and contraction were expressed as filling fraction (FF) at 90 min and ejection fraction (EF) at 30 min after a fatty diet by Tc-99m DISIDA cholescintigraphy. A total of 12 patients who had symptomatic gallstones without cholecystitis were included in our study. ESWL failed in three cases: FF decreased in two of three cases and increased in one of three cases, whereas EF decreased in two of three cases and increased in one of three cases. In another nine cases, ESWL was successful and the gallstones were fragmented. One month after ESWL, in three of these nine cases, the gallstones had completely disappeared. In the three cases at 1 month after ESWL, FF decreased in two of three cases and increased in one of three cases, whereas EF decreased in one of three cases and increased in two of three cases. In the remaining six cases after ESWL, there were still some residual stone fragments in the gallbladder. In these six cases after 6 months, no fragments were found in the gallbladders, the third Tc-99m DISIDA cholescintigraphy was performed. In these six cases, the changes of FF and EF, before ESWL, 1 month after ESWL, and 6 months after ESWL, were irregular and fluctuant. However, no significant improvement of gallbladder function was demonstrated even when ESWL was successful.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Cholelithiasis; Gallbladder; Gallbladder Emptying; Humans; Imino Acids; Lithotripsy; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

One hundred eighty-seven patients who presented with symptoms consistent with biliary colic but had no ultrasonic evidence of cholelithiasis were observed in an effort to identify those with a functional gallbladder disorder that might benefit from surgical intervention. All patients underwent quantitative evaluation of gallbladder emptying using cholecystokinin biliary scanning, and ejection fractions less than 35% were considered abnormal. One hundred twenty-nine patients (69%) had abnormal ejection fractions, and 88 (68%) of these subsequently underwent cholecystectomy. Sixty of the surgical specimens revealed pathologic changes. Eighty-four percent of patients successfully contacted for follow-up experienced complete relief, and another 13% had partial relief of preoperative symptoms. Only two patients reported no change in symptom complex. Twenty-nine patients with abnormal ejection fractions elected not to undergo surgery. Fifty-nine percent of these patients continued to experience symptoms of biliary colic at a mean follow-up of 22 months. Of the 44 patients with normal ejection fractions, 35 (80%) reported resolution of symptoms during follow-up of medical treatment. Cholecystokinin biliary scanning can help identify patients with acalculous, functional gallbladder disease who may benefit from cholecystectomy.

Topics: Adult; Biliary Dyskinesia; Cholecystectomy; Cholecystitis; Cholecystokinin; Cholelithiasis; Diagnosis, Differential; Female; Follow-Up Studies; Gallbladder; Gallbladder Diseases; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Disofenin

Extracorporeal shock wave lithotripsy (ESWL) has been reported to be a safe and relatively effective non-invasive treatment for radiolucent gallbladder calculi in selected patients. Ideally, the goal of successful treatment is the passage of all fragments from the gallbladder into the intestinal tract. Biliary colic has been reported in up to 35% of treated patients, although complications such as cholecystitis, cholangitis, common bile duct obstruction, and pancreatitis are surprisingly infrequent. Cholescintigraphy is the procedure of choice in patients with biliary colic and suspected acute cholecystitis. It has proven to be more sensitive than ultrasound in detecting acute common bile duct (CBD) obstruction, since functional obstruction precedes morphologic dilatation of the CBD. This report reviews two cases of post-lithotripsy cystic and common duct obstruction and discusses the role of Tc-DISIDA scintigraphy following gallstone ESWL.

Topics: Adult; Cholelithiasis; Cholestasis; Cholestasis, Extrahepatic; Common Bile Duct Diseases; Cystic Duct; Female; Humans; Imino Acids; Lithotripsy; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Topics: Cholelithiasis; False Negative Reactions; Female; Humans; Imino Acids; Middle Aged; Morphine; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Topics: Adolescent; Adult; Aged; Cholecystitis; Cholecystography; Cholelithiasis; Chronic Disease; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Disofenin

During the intestinal phase of hepatobiliary imaging studies in four patients, unusual small intestinal abnormalities were noted. These findings were correlated with surgery in three patients. Recognition of these patterns gives additional clinical information of significant diagnostic value. Further attention to small intestinal pattern and/or radionuclide evaluation of small intestine is a promising method of noninvasive evaluation of clinically suspected small intestinal infarction and obstruction.

Topics: Adult; Aged; Cholecystitis; Cholelithiasis; Cholestasis, Intrahepatic; Diagnosis, Differential; Female; Humans; Imino Acids; Infarction; Intestinal Diseases; Intestinal Obstruction; Intestinal Perforation; Intestine, Small; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Thrombosis

A 66-year-old woman with known gallstones and peptic ulcer disease presented with acute epigastric pain. Cholescintigraphy revealed nonvisualization of the gallbladder with subhepatic and perihepatic accumulation of tracer. An upper gastrointestinal examination with water-soluble contrast revealed a perforated duodenal ulcer, with leakage confirmed at laparotomy. The gallbladder was intact.

Topics: Aged; Biliary Fistula; Cholelithiasis; Diagnosis, Differential; Duodenal Ulcer; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Imino Acids; Organometallic Compounds; Peptic Ulcer Perforation; Radionuclide Imaging; Technetium Tc 99m Disofenin

We have described a patient who was admitted to the hospital for evaluation of RUQ abdominal pain 40 years after a Billroth II gastrectomy, as well as a cholecystectomy of which the patient was unaware. Gray-scale abdominal ultrasonography and Tc 99m-IDA hepatobiliary imaging were interpreted as revealing an enlarged gallbladder and cholelithiasis. An obstructed afferent loop of the Billroth II anastomosis had mimicked a gallbladder on ultrasonography and hepatobiliary imaging.

Topics: Afferent Loop Syndrome; Aged; Bezoars; Cholecystectomy; Cholelithiasis; Chronic Disease; Diagnosis, Differential; Gallbladder; Humans; Imino Acids; Male; Postgastrectomy Syndromes; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

Cholescintigraphy is a sensitive procedure for diagnosing or excluding acute cholecystitis. However, when rapid diagnosis is critical, the requirement for delayed images (4 hr or more after injection) to minimize the false-positive rate diminishes its utility. We prospectively evaluated 40 cholescintigraphic examinations that did not visualize the gallbladder 1 hr after injection of 99mTc diisopropyliminodiacetic acid. These examinations were then augmented by administration of IV morphine, followed by an additional 30 min of imaging. After the morphine, 18 of these examinations demonstrated visualization of the gallbladder; none subsequently required surgical exploration. Of the remaining 22, who demonstrated persistent nonvisualization of the gallbladder post-morphine, 11 were explored surgically and found to be abnormal. The 11 others were treated medically. Low-dose morphine administered when the gallbladder fails to visualize after 1 hr is a useful adjunct to conventional cholescintigraphy because it reduces the time required to obtain a diagnostic result and decreases the number of false-positive results.

Topics: Acute Disease; Biliary Tract; Cholecystitis; Cholelithiasis; False Negative Reactions; Humans; Imino Acids; Morphine; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

To determine the sensitivity of hepatobiliary imaging (HBI) and strict- and liberal-criteria real-time ultrasonography (RTUS), we retrospectively analyzed 100 cases of pathologically proved acute cholecystitis (AC). A positive HBI was one in which there was nonvisualization of the gallbladder up to four hours after the administration of technetium Tc 99m-disofenin. In the absence of hypoalbuminemia, cirrhosis, or ascites, pathognomonic RTUS findings (strict criteria) for AC were wall edema and/or pericholecystic fluid. Findings indicative of AC (liberal criteria) included the demonstration of stones, a thick gallbladder wall, nonshadowing echoes, or the ultrasonographic Murphy's sign. Of the 100 cases of AC, 91 were calculous, and nine were acalculous. Four of 100 patients had associated choledocholithiasis. The sensitivities in detecting calculous AC were as follows: HBI, 97%; liberal-criteria RTUS, 86%; and strict-criteria RTUS, 24%. The sensitivities in detecting acalculous AC were as follows: HBI, 100%; liberal-criteria RTUS, 89%; and strict-criteria RTUS, 44%.

Topics: Acute Disease; Biliary Tract; Cholecystitis; Cholelithiasis; Gallstones; Humans; Imino Acids; Liver; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

Biloma resulting as a complication of cholcecystectomy is rarely reported. Infection and rupture of biloma into the peritoneal cavity is a reported complication that may need aggressive surgical management. A case of infected biloma is presented in which an active biliary leak was demonstrated on a hepatobiliary scan with Tc-99m DISIDA.

Topics: Bile; Biliary Tract Diseases; Cholecystectomy; Cholecystitis; Cholelithiasis; Drainage; Female; Humans; Imino Acids; Middle Aged; Peritoneal Cavity; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Hepatobiliary imaging was performed in a woman who, at subsequent surgery, was found to have gallstone ileus due to a large gallstone obstructing the proximal jejunum. The triad of findings (failure of the radiopharmaceutical to pass beyond the point of obstruction, marked reflux into the stomach, and nonvisualization of the gallbladder) is nonspecific but, in the appropriate clinical setting, should suggest the possibility of gallstone ileus.

Topics: Aged; Biliary Tract; Cholelithiasis; Female; Humans; Imino Acids; Intestinal Obstruction; Liver; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

A study was undertaken to establish the pattern of gallbladder emptying in normal subjects and in patients with gallstones, using a fatty meal as stimulus to release endogenous cholecystokinin. The time from meal ingestion to beginning of gallbladder emptying (latent period), the total duration of emptying (ejection period), degree of emptying (ejection fraction), and the rate of emptying (ejection fraction/ejection period) were measured noninvasively by a nongeometric scintigraphic technique. The mean latent period and ejection rate were similar in normal subjects and patients with gallstones, but the mean ejection period and ejection fraction were significantly reduced in the patients. This study suggests that for an identical stimulus, the gallbladder in cholelithiasis begins to empty at the normal time but empties for a shorter duration; the result is a reduction of ejection fraction but not of ejection rate.

Topics: Adult; Aged; Bile; Cholelithiasis; Computers; Dietary Fats; Gallbladder; Humans; Imino Acids; Kinetics; Male; Middle Aged; Muscle Contraction; Radionuclide Imaging; Statistics as Topic; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin

A 47-year-old man presented with the clinical findings of acute cholecystitis. During hepatobiliary scintigraphy using Tc-99m DISIDA, a persistent photopenic defect was noted within the inferior portion of the liver in the region of the gallbladder. Abdominal ultrasonography revealed large gallstones with acoustic shadowing within a normal-sized gallbladder. Eleven large gallstones were found within a normal-sized intrahepatic gallbladder at surgery.

Topics: Cholelithiasis; Gallbladder; Humans; Imino Acids; Liver; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

The influence of scan and pathological criteria on the specificity of cholescintigraphy was assessed by a prospective study of 211 patients with suspected acute cholecystitis who underwent cholescintigraphy. Sufficient data were available in all to confirm a final diagnosis. Cholescintigraphy was performed in the standard fashion using 5 mCi of Tc-99m disofenin. Sixty patients had acute cholecystitis, 64 had chronic cholecystitis, and 87 had no demonstrable gallbladder disease. As the scan and pathological criteria for acute cholecystitis were varied from strict to liberal, the sensitivity of cholescintigraphy decreased (100% to 95.3%), the specificity increased (85.1% to 98.6%, and the predictive value increased (68.4% to 96.8%). The use of strict scan and pathological criteria for acute cholecystitis obscures the advantages that accrue from such early detection of acute cholecystitis by cholescintigraphy, and thus are to be avoided. To understand the disparate opinions voiced in the literature, an appreciation is required for the effects of changes in criteria on the specificity and predictive value of cholescintigraphy.

Topics: Acute Disease; Cholecystitis; Cholelithiasis; Gallbladder; Humans; Imino Acids; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors; Ultrasonography

Technetium-99m iminodiacetic acid (IDA) cholescintigraphy was performed in 15 patients with acute acalculous cholecystitis. Fourteen of the 15 patients with acute disease had positive findings, indicating the presence of cystic duct or common duct obstruction. One case in which the gallbladder was visualized failed to respond to sincalide stimulation; this was classified as a suggestive finding of disease. The diagnostic accuracy of 99mTc-IDA cholescintigraphy was far superior to the other imaging studies used (8 sonograms, 1 intravenous cholangiogram, 3 oral cholecystograms, 1 percutaneous transhepatic cholangiogram). The 99mTc-IDA study is recommended as the imaging procedure of choice for examining patients with suspected acute acalculous cholecystitis.

Topics: Acute Disease; Aged; Cholecystitis; Cholelithiasis; Cholestasis; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin

The effect of etiology on findings in cholescintigraphy in patients with extrahepatic obstruction was retrospectively evaluated in 29 patients. Of 11 patients with obstruction secondary to cancer, seven (78%) of nine had complete obstruction (delayed images were not obtained in two) and nine (82%) of 11 had a moderate to severe decreases in hepatocyte clearance. Of 12 patients with obstruction secondary to cholelithiasis, only four (36%) had complete obstruction (delayed images were not obtained in one) (p less than 0.05) and all 11 had normal or only midly decreased hepatocyte clearance (p less than 0.05). All five patients with obstruction secondary to pancreatitis had mild partial obstruction and normal or mildly decreased hepatocyte clearance. One patient had partial obstruction secondary to an abscess adjacent to the common bile duct; hepatocyte clearance was mildly decreased. Cancerous and noncancerous causes of biliary tract obstruction produce significantly different findings in hepatobiliary imaging.

Topics: Abscess; Aged; Bile Duct Diseases; Cholelithiasis; Cholestasis, Extrahepatic; Humans; Imino Acids; Male; Middle Aged; Neoplasms; Pancreatitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin

Topics: Biliary Tract; Cholecystitis; Cholelithiasis; Humans; Imino Acids; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Aged; Cholelithiasis; Gallbladder Diseases; Humans; Imino Acids; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Tc-99m disofenin, a derivative of iminodiacetic acid, was used to evaluate the biliary tract of 28 children who had a total of 33 examinations. This radiopharmaceutical was rapidly cleared from the blood by the hepatocytes and yielded excellent images of the biliary system. Renal activity did not present difficulty in image interpretation. It provided clinically useful information in a bilirubin range of 0.3 to 14.1 mg/dl. The major categories of acquired and congenital biliary tract abnormalities in children presented no diagnostic difficulty with Tc-99m disofenin.

Topics: Biliary Tract; Child; Cholelithiasis; Cholestasis, Intrahepatic; Hepatitis; Humans; Imino Acids; Infant, Newborn; Infant, Newborn, Diseases; Jaundice; Liver; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin